Bergmann K E, Bergmann R L, Von Kries R, Böhm O, Richter R, Dudenhausen J W, Wahn U
Robert Koch Institute, Epidemiology & Health Reporting, Health of Children & Adolescents, Berlin, Germany.
Int J Obes Relat Metab Disord. 2003 Feb;27(2):162-72. doi: 10.1038/sj.ijo.802200.
The prevalence of adiposity in childhood is increasing. Is breast-feeding protective as suggested by cross-sectional studies?
In a longitudinal birth cohort study, we tested whether breast-feeding for more than 2 months has preventive effects against overweight and adiposity at 6 y.
Of 1314 children representing the catchment areas of six delivery units, 918 could be followed up to the age of 6 y. Height, weight, and skin-fold thickness were measured at regular visits. As the criteria of overweight, obesity, and adiposity in the children, the 90th and the 97th percentiles of BMI and skin-fold values were used. Parents with a BMI at or above the 90th percentile, which was 27 kg/m(2) or more, were considered overweight. Infants bottle-fed from birth or breast-fed for less than 3 months were classified as 'bottle-fed' (BO), and those breast-fed for 3 months and more as 'breast-fed' (BR). Univariate comparisons and logistic regression analysis were performed applying SAS 6.12. The final logistic model consisted of the 480 cases for whom complete data for all variables were available. The potential effect of loss to follow-up was analysed by the Cochran-Mantel-Haenzel test: the outcomes were not significantly influenced by loss to follow-up.
At birth BMIs were nearly identical in both groups. By 3 months, BO had significantly higher BMIs and thicker skin folds than BR. From 6 months on, compared to BR, a consistently higher proportion of BO children exceeded the 90th and the 97th percentile of BMI and skin-fold thickness reference values. From the age of 4 y to 5 and 6 y, in BO the prevalence of obesity nearly doubled and tripled, respectively. With only minor changes of obesity prevalence in BR, the difference of BMI and skin-fold thickness between groups became statistically significant. Logistic regression analysis revealed that overweight of the mother, maternal smoking during pregnancy, bottle feeding, and low social status remained important risk factors for overweight and adiposity at 6 y of age.
A maternal BMI of > or =27, bottle-feeding, maternal smoking during pregnancy, and low social status are risk factors for overweight and adiposity at 6 y of age. Early bottle-feeding brings forward the obesity rebound, predictive of obesity in later life.
儿童肥胖的患病率正在上升。母乳喂养是否如横断面研究所表明的那样具有保护作用？
在一项纵向出生队列研究中，我们测试了母乳喂养超过2个月是否对6岁时的超重和肥胖具有预防作用。
在代表六个分娩单位集水区的1314名儿童中，918名儿童能够被随访至6岁。在定期访视时测量身高、体重和皮褶厚度。作为儿童超重、肥胖和肥胖的标准，使用BMI和皮褶值的第90和第97百分位数。BMI在第90百分位数及以上（即27kg/m²或更高）的父母被视为超重。从出生就用奶瓶喂养或母乳喂养少于3个月的婴儿被归类为“奶瓶喂养”（BO），母乳喂养3个月及以上的婴儿被归类为“母乳喂养”（BR）。使用SAS 6.12进行单变量比较和逻辑回归分析。最终的逻辑模型由所有变量都有完整数据的480例病例组成。通过Cochran-Mantel-Haenzel检验分析失访的潜在影响：结果未受到失访的显著影响。
两组儿童出生时的BMI几乎相同。到3个月时，奶瓶喂养组的BMI和皮褶厚度明显高于母乳喂养组。从6个月起，与母乳喂养组相比，奶瓶喂养组中始终有更高比例的儿童超过BMI和皮褶厚度参考值的第90和第97百分位数。从4岁到5岁和6岁，奶瓶喂养组的肥胖患病率分别几乎增加了一倍和两倍。母乳喂养组的肥胖患病率仅有轻微变化，两组之间BMI和皮褶厚度的差异具有统计学意义。逻辑回归分析显示，母亲超重、孕期母亲吸烟、奶瓶喂养和社会地位低仍然是6岁时超重和肥胖的重要危险因素。
母亲BMI≥27、奶瓶喂养、孕期母亲吸烟和社会地位低是6岁时超重和肥胖的危险因素。早期奶瓶喂养会提前出现肥胖反弹，这预示着日后肥胖。
